Improving Provider Competency to Enhance Safety in Dermal Filler Procedures: A QSEN and Benner-Guided Program

Aesthetic nursing has rapidly expanded without standardized training to ensure provider competency, increasing the potential for adverse events (AEs). While most dermal filler AEs are minor, serious complications including vascular compromise, can occur. This quality improvement project aimed to reduce dermal filler AEs by implementing an evidence-based competency assessment program for aesthetic providers using the Quality and Safety Education for Nurses (QSEN) framework and Benner's Novice to Expert model. Our objective was to improve patient safety by decreasing dermal filler AEs through standardized evaluation of provider knowledge, skills, and attitudes (KSAs). To achieve this, we developed three assessment tools: a dermal filler knowledge self-assessment, a skills observation checklist, and a competency assessment tool structured around QSEN's KSAs, integrated with Benner's competency progression. Ten licensed aesthetic injectors participated across two clinical sites. Data were collected over 16 months: 6 months pre-intervention, a 4-month implementation phase, and 6 months postintervention. AEs were categorized as lumps, asymmetry, vascular events, or other complications. All providers demonstrated competence across assessed domains. Total AEs declined by 65%, from 97 to 34 events and vascular events dropped from four to zero. Implementation costs totaled $5,000, while estimated savings from reduced AE-related expenses exceeded $12,000 within 6 months. These results indicate that a structured competency program grounded in QSEN and Benner's framework can significantly improve injection safety and reduce complications. This model is replicable in other aesthetic practice settings and provides a foundation for competency-based training in high-risk, elective procedures, supporting both provider development and patient safety.